Provider Demographics
NPI:1528320272
Name:MUTHINENI, SUMALATHA (MBBS)
Entity type:Individual
Prefix:DR
First Name:SUMALATHA
Middle Name:
Last Name:MUTHINENI
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:
Other - First Name:SUMALATHA
Other - Middle Name:
Other - Last Name:KAKUMANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3901 RAINBOW BLVD # MS 1005
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66160-8500
Mailing Address - Country:US
Mailing Address - Phone:913-588-1466
Mailing Address - Fax:913-588-1201
Practice Address - Street 1:3901 RAINBOW BLVD # MS 1005
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160-8500
Practice Address - Country:US
Practice Address - Phone:913-588-1466
Practice Address - Fax:913-588-1201
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-08
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS94-07895207QG0300X
KS9407895207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine